In this space we’ve read about the efforts of “alternative” practitioners such as naturopaths to gain the moniker “primary care provider”. I’ve been wondering a bit about this. I’m a primary care physician. Specialists in internal medicine, pediatrics, and family medicine provide the bulk of primary care in the U.S. They attend a 4-year medical school, complete a 3-4 year residency, take their specialty board, and then work as experts in the screening, prevention, diagnosis, and treatment of common diseases.
So, what I’d like to do is give you a typical scenario from an internal medicine or family medicine practice. It’s a simple one, one you might see on Step II of the USMLE boards or on a shelf exam for an internal medicine rotation. I’d like to offer alternative practioners, especially naturopaths, an opportunity to show how they would approach the clinical scenario so that we can see what kind of primary care they provide.
Yes, every patient and every situation is different, but there are some general ways to approach health and disease based on the evidence.
A 52 year old woman comes to see you for the first time. She has not been seeing doctors very much over the last few years. She has a known history of hypertension, diabetes, and gout, but is not currently receiving any treatment. Her only unsolicited complaints are some excess urination and some indigestion.
On exam, she has a blood pressure of 162/92 (which correlates with her checks at the drug store), a weight of 62 kg, and a fasting blood sugar of 353. Her LDL cholesterol from a health fair at work was 138.
1) What basic health screening should a primary care physician offer for this patient?
2) What screening a prevention should the patient be offered based on the information available?
3) What interventions, pharmacologic and otherwise, must be offered the patient?
This is a typical scenario faced by PCPs several times a day. If you want to play with the big kids, you’d better be able to give a good answer.
I’ll ask MDs and DOs to please refrain from answering the question so that we can give the NDs, etc. time to formulate answers that won’t harm the patient and that wouldn’t get the typical primary care physician sued.